| NPI | 1174377436 |
|---|---|
| Other Name | DIANA GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: IL 043130712) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WI 326568-31) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-15 |